Active voluntary euthanasia may be defined as the deliberate taking of a patient's life, or the facilitation of his or her suicide, with the informed consent and at the express request of the patient. It may therefore be distinguished from passive euthanasia, when no positive step is taken to hasten death but when potentially life-saving measures are intentionally withheld, and also from non-voluntary euthanasia, when the patient is unable to participate in the decision, or is incapable of providing an adequately informed consent.

The sudden collapse of the communist order in Czechoslovakia and the formal installation of the new government in June 1990 has led, inter alia, to a fundamental reappraisal of mental health care. On a visit to Prague in September 1990 the system under the 40-year-old communist regime was still largely intact but clearly about to undergo major changes. Among the reform proposals made by a working group of the Ministry of Health and Social Affairs of the Czech republic are practices familiar to western psychiatrists: mental health care and specialist liaison in primary care settings; formal specialisation within psychiatry into general adult psychiatry, psychogeriatrics, child and adolescent psychiatry, psychotherapy; psychiatric units in general hospitals; community care with restructuring of funding away from the mental hospital budget and devolution to districts. More “humanisation” of psychiatry is envisaged, with choice of consultant, increased competition between doctors and legal definitions of involuntary treatment (Potucek et al, 1990). Voluntary organisations, existing until recently only underground, will be encouraged as also will be counselling services. Dementia, and drugs and alcohol misuse, are seen more as social service than medical issues. Of particular interest is a proposal to separate mental health funding from the rest of the health care budget.

In-patient psychotherapy at the Cassel Hospital will continue at least for the time being. Early last year, however, its future was in doubt. In January, the managing health authority, Riverside, faced an annual spending deficit of £6.7 million. The hospital costs £1.25 million to run each year; in February, district management recommended closure of the 70 year old Cassel as the top item on their proposed shortlist of economy measures.

The Marital and Sexual Difficulties Clinic at Sheffield offers out-patient treatment that is usually based on a modified Masters & Johnson method. This consists of behavioural techniques, notably sensate focus, used within a psychoanalytic background.

There is an increasing momentum for the provision of care for people with chronic mental illness to be made in settings other than mental hospitals. One concern arising from this shift in emphasis is with those patients who may find it particularly difficult to live in the community.

The community psychiatry service in Bassetlaw District has been developing since 1984 and provision includes hospital hostels, supervised flatlets, nursing and rest homes, group homes, cluster flats and warden assisted accommodation. Close liaison with an enthusiastic Local Authority Housing Department has also led to the development of a new initiative, an unstaffed flat for use in crisis intervention and rehabilitation. Placements in the flat are described over the first 12 months of its existence.

The old age psychiatrist's role has been evocatively described as “physician to the soul of the elderly”. A more practical definition is psychiatrist to patients over the age of 65 with both functional and organic illnesses.

In view of the increasing emphasis on community psychiatry (Groves, 1990), there is much interest both locally and nationally as to what training experience is available or should be provided. So far, trainees have been bombarded by suggestions as to the essential content of training (e.g. Connolly & Marks, 1989), and enthusiastic accounts of experience gained have been published (e.g. Malcolm, 1989). Not surprisingly, anxiety has also been expressed (Haigh & Wear, 1989).

Keele received its Charter as the University College of North Staffordshire in 1950. The first Vice Chancellor was Lord Lindsay, formerly the Warden of Magdalen College, Oxford. In the pre-war years Lindsay was a frequent visitor to the Potteries, presenting lectures within the Workers Education Association. He was unusual as an Oxford don not only in this respect but also in his approach to university education. He was closely involved in the development of the Modern Greats degree at Oxford and had strong views on the need for a broad liberal university education. Keele was founded on this principle as a teaching university offering a four year degree, the foundation year requiring students to study arts, sciences and humanities. At its inception the university was housed in a Victorian stately home, Keele Hall, and several ex-army huts. For the first decade of its life a “community of scholars” ethos was strongly emphasised and academics as well as students were required to live on campus. There were weekly small group student seminars involving academics from the three different disciplines. The academics look back on these seminars fondly, although it is not clear whether the students derived the same enjoyment from these interdisciplinary talking shops.

Dr Michael Robinson, of the London School of Hygiene and Tropical Medicine, dealt with more general aspects and Dr Ann Gath, Registrar of the College and Chairman of the Medical Audit Working Party, with aspects of particular relevance to psychiatry.

Medical audit has been defined as the systematic, critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome and quality of life for the patients (Department of Health, 1989). The medical profession has been under pressure to extend and improve audit procedures in recent years (McKee et al, 1989), but there have been doubts about the most satisfactory methods, particularly in psychiatry (Garden & Oyebode, 1989). There are numerous methodological problems in measuring the outcome of psychosocial care (Shaw, 1989; Royal College of Psychiatrists, 1989). Indicators of outcome which have been used in medicine include incidence of adverse events. Reintervention rates do offer some measure of outcome, and have been used widely in other medical specialities.

In 1886, the Medico-Psychological Association established its own examinations leading to a certificate of psychological medicine. Although discussions concerning the setting up of this certificate clearly indicated that it was regarded as a qualification for men, by 1888 women medical practitioners were sitting the examination and appear, without comment, in the lists of successful candidates. However, the question of the admission of lady members to the Association proved to be a much more controversial matter.

It is in the nature of eagles to fly. It is in the nature of human conditioning to develop attachments and aversions. The story is told of the court monkey who finds a luscious fruit inside a narrow-necked bowl. When the fruit is grasped however the monkey's full fist does not allow him to withdraw his hand, yet to the amusement of onlookers he will not relinquish the object of his desire. How foolish!

The Academic Sub-Department of Psychological Medicine in North Wales was opened on 19 October 1990 by Professor Andrew Sims, President, The Royal College of Psychiatrists.

William Cullen (1710–1790) was the greatest teacher of clinical medicine in Britain in the 18th century. He was born in Hamilton in Lanarkshire and began his career in Glasgow where he held the chair of chemistry and was one of the founders of the medical school. In 1755 he moved to Edinburgh with its already flourishing medical school and its new hospital, the Royal Infirmary, and there he held in succession the chairs of chemistry, the institutes (theory) of medicine and the practice of physic. Together with Alexander Monroe he made Edinburgh the most famous medical school in the Western world and students came from far and wide to be taught by him – from England, Scotland and Ireland, from the Americas and the West Indies and from the Continent. Like Boerhaave, his reputation rested mainly on his gifts as a teacher and it is clear that his students idolised him. Benjamin Rush, the founder of the first medical school in the New World in Philadelphia, America's first psychiatrist and one of the signatories of the American Declaration of Independence, wrote of him that “It is scarcely possible to do justice to this great man's Character either as a scholar, a physician, or a Man”.

The Special Hospitals Service Authority (SHSA) has commissed KPMG Peat Marwick McLintock Management Consultants to lead a pilot study to identify how the application of resource management (RM) techniques can best be introduced to the overall benefit of the management of a Special Hospital. The study is to be based at Rampton Hospital. The KPMG staff will work closely with a Project Team comprised of the hospital's staff.

Observers of the American Psychological Association's enthusiastic support for the gathering momentum to accredit psychologists with prescribing privileges will detect professional and economic motives among others: the same can also be said of the AMA's campaign to stop it. Health care in the USA is underpinned by a business culture in which psychologists and psychiatrists operate widely as independent practitioners in the open market place. The prestige value and pecuniary advantages to American psychologists would not be insignificant. Also, since health care insurance companies purchase separate psychological and medical treatment for their customers, it would be to their economic advantage for these treatments to be embodied in one individual. Thankfully, pressures on this scale have yet to reach these shores. Nevertheless, serious consideration should be given to establishing a grade of prescribing psychologist in the NHS if it can be shown to raise the overall quality of care; if prescribing could be done appropriately and safely; and if this did not detract from the quality of psychological intervention.